Abstract
Chronic diseases – such as Type 2 Diabetes (T2D) and hypertension (HTN) – are on the rise globally, regardless of country income levels. A vast range of policy initiatives and interventions stimulates principles of integrated care – to prevent and manage T2D and HTN. These integrated care interventions, shown to be effective in small-scale settings, whilst mostly not technically nor medically complex, tend to be organizationally challenging: they require system changes and coordinated actions from different actors and institutions to achieve maximal effect.
The global challenges common to many health systems call for an analysis across contexts. Through reciprocal learning of new avenues towards integrated care between different projects and contexts, we aim to increase the understanding of the relationships between context, intervention, implementation and impact. The ‘Scaling up an integrated care package for diabetes and hypertension for vulnerable people in Cambodia, Belgium & Slovenia (SCUBY; https://scuby.eu)’ project funded by the European Commission), aims to address the above-cited challenges through roadmaps to scale-up clearly defined, evidence-based, integrated care interventions. These interventions, comprising of (a) early detection and diagnosis, (b) treatment in primary care services, (c) health education, (d) self-management support to patients and caregivers, and (e) collaboration between caregivers, compose an ‘integrated care package’ (ICP). The project implements and evaluates the scale-up of the ICP in purposively selected types of health systems: a developing health system in a lower middle-income country (Cambodia); a centrally steered health system in a high-income country (Slovenia); and a publicly funded highly privatized health-care health system in a high-income country (Belgium). Country-specific scale-up strategies are co-developed and implemented together with a wide range of stakeholders, including policy makers, health care professionals, community groups and patients (organizations). The ensuing evaluation assesses changes in the structure, process and outcomes of care. A three-dimensional framework evaluates scale-up along three axes: (1) increase in population coverage; (2) expansion of the ICP; and (3) integration of the ICP into the health system referring to the degree to which governance arrangements, organization, financing and service delivery allow the ICP to be adopted and diffused in the health system.
The SCUBY project aims to provide guidance for scaling-up practices of integrated care interventions through a compilation of articles in a thematic issue in the International Journal of Integrated Care with a focus on chronic diseases in a variety of contexts. The aims of this workshop will be: 1) to provide an overview of the present state of the art of research of scale-up of integrated care; 2) to launch the thematic issue; and 3) to reflect and exchange with researchers, policy makers and beneficiaries.
Session organization: Part 1) Bird’s eye on the research landscape (Viktoria Stein, 10 min). Part 2) Launch: Presenting the special issue and contributions to the field (Kerstin Klipstein-Grobusch, 15 min). Part 3) Panel discussion with 6 people (2 SCUBY researchers, 2 policy makers, 2 beneficiaries, led by Jason Yap, 45 min). Part 4) Open interaction with audience and synthesis (workshop leader, 15 min).